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• W1997728526 abstract "Randomized Clinical Trials (RCT) are the cornerstone of evidencebased medicine. Physicians, neurologists, movement disorders specialists, policy makers, politicians and the public are all intensely interested in the results of RCTs to guide treatment of illness and determine what is “approved” for insurance purposes as a “proven” therapy. The assumption is that the results of RCTs provide the answer to the question posed in this article – “What do clinical trials tell us about treating patients?” Not only is the assumption that RCTs provide the specific answer of the best approach to treating an individual patient, there is also the widespread opinion (belief) that if there is no RCT, there is no evidence-based medicine solution and therefore treatments without RCT evidence are not evidencebased and not of value – literally not helpful to patients and not worth paying for. Much of the discussion of the “waste” in the United States health care system is laid at the doorstep of “unproven treatments” which do not improve our health, but are costly. This article will review the strengths and weaknesses of RCTs. In particular, it will describe the relationship of trial results to an individual patient. In movement disorders, a large number of RCTs have been conducted over the last 30 years which have advanced our understanding of the treatment of Parkinson’s disease, dystonia, tics, Huntington’s disease, tardive dyskinesia and more. In Parkinson’s disease carefully conducted pharmaceutical industry and federally supported trials of new therapeutic agents have helped neurologists to determine “best” possible treatment strategies for their patients. Despite the wealth of RCT data, controversy about aspects of treating de novo Parkinson’s disease patients continue [1–4]. This article will not discuss the specifics of any of these outcome trials – e.g., levodopa vs. each of the agonists [5–9], COMT inhibitors in motor fluctuations of Parkinson’s disease [10,11], MAO inhibitors in early and advanced Parkinson’s disease [12–14] or the numerous failed neuroprotection trials [15– 18]. Instead, the role of RCTs in establishing therapy and how that therapy relates to individual patients will be addressed." @default.
• W1997728526 created "2016-06-24" @default.
• W1997728526 creator A5074151067 @default.
• W1997728526 date "2009-12-01" @default.
• W1997728526 modified "2023-09-23" @default.
• W1997728526 title "What do clinical trials tell us about treating patients?" @default.
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• W1997728526 doi "https://doi.org/10.1016/s1353-8020(09)70776-x" @default.
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